APPLICATION FORM

YOUNG MEPS FOR EUROPEAN DEMOCRACY!

PERSONAL DATA

Name

Surname

Gender Female Male

e-mail

Phone no.Date of birth

(dd.mm.yyyy)Age (years as to 31 March

2014)Country

City

Knowledge of English (please check one answer)1. Basic 2. Advanced 3. Proficient

Describe your motivation to participate in the MEP`s Incubator and EP Simulation (please write below why you wish to take part in the project; describe your knowledge about EP, previous experience in Youth in Action program or other projects with similar topic)

What are the most important things you expect from the Project(please choose max. 3 answers)1. Meeting new people 2. Learning about new cultures 3. Acquiring new skills 4. Practicing English language 5. General self-development 6. Establishing new partnerships

1

7. Getting knowledge on European issues 8. Exchanging knowledge 9. Other (please write below)

Are you a vegetarian/vegan?1. No 2. Yes, I’m a vegetarian 3. Yes, I’m a vegan

Do you have any particular needs with regards to accommodation, food or any other important matter? (please write below what are those needs and why they are important)

Please write what are your hopes and expectations from the Project?(Please write approximately 2-3 sentences)

Contact person at home in case of emergency

NameSurnameRelationshipPhone noI hereby agree for processing the following personal information strictly for the purposes of the Youth in Action project: “Young MEP`s for European Democracy!” in accordance with the regulation for the protection of personal data passed on the following day: 29.08.97r. DzU nr 133 poz. 883.

Date Signature

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I hereby permit to use my images for the purpose of activities undertaken within the scope of “Young MEP`s for European Democracy!” project. The permission includes use, recording, processing and reproduction of photographs and films via digital and printed media.

Date Signature

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